Provider Demographics
NPI:1083770069
Name:CHENEY, RICHARD E (OD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:E
Last Name:CHENEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 WHITE OAK LN
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-3822
Mailing Address - Country:US
Mailing Address - Phone:419-991-3001
Mailing Address - Fax:
Practice Address - Street 1:1593 ALLENTOWN RD
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-2205
Practice Address - Country:US
Practice Address - Phone:419-228-9176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH 3334152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist